Dorota Ortenburger, Jacek Wasik,
Alena Bukova, Tomasz Gora
Comparison of strategies used by
patients undergoing treatment...
Ido Movement for Culture : journal of martial arts anthropology : theory of culture, psychophysical culture, cultural tourism, anthropology of martial arts, combat sports 16/3, 40-46
PSYCHOLOGY
Dorota Ortenburger
1(ABCDEFG), Jacek Wasik
1(ACDEFG), Alena Bukova
2(ADEFG),
Tomasz Gora
1(BEFG)1 Institute of Physical Education, Tourism and Physiotherapy, Jan Dlugosz University, Czestochowa (Poland),
address: ul. Armii Krajowej 13/15; 42-200 Czestochowa (Poland)
2 Institute of Physical Education and Sport, Pavol Jozef Safarik University, Kosice (Slovakia)
address: ul. Ondavska 21, Kosice, Slovakia; contact e-mail: alena.bukova@upjs.sk
Comparison of strategies used by patients undergoing treatment
for chronic pain people performing taekwon-do – a pilot study
Submission: 30.11.2015; acceptance: 14.02.2016
Key words: taekwon-do, strategies for coping with pain, psychological factors, proactive
Abstract
Background. An assumption was made that mental condition has an impact, playing an active role in both pain treatment and martial arts. In the light of the referenced literature concerning health psychology it may be related to the main of beliefs and psy-chological strategies concerning individuals’ability to cope with pain.
Aim. The aim of this work is to present the results of research dealing with pain in two different groups: patients undergoing treat-ment for chronic pain and a group of people practising taekwon-do.
Method. The paper presents the results of research conducted on two groups, considerably different in respect of their physical fitness. The first group was composed of 29 individuals who practise taekwon-do (30.5±8.9 years). The second group comprised 30 pain treatment patients (33.5±11.9 years). Questionnaires used in psychology and health promotion were applied in the research to collect relevant pain-related data (Coping Strategies Questionnaire and Pain Beliefs Questionnaire).
Results. The results obtained indicated that taekwon-do trainees use strategies for coping with pain on their own more fre-quently than patients. They are also more proactive 8,17±1,94 (cluster 1) and 6,50±3,03 (cluster 2) than patients 3,01±0,82 (cluster 1) and 5,05±1,95 (cluster 2). The type P strategy in the taekwon-do group was 11.53±3.91, while for patients it is 13.68±4.64. A strategy based on trusting doctors, was 10.87± 4.09 in the taekwon-do group and for patients was 11.71 ± 5.02. Conclusions. Taekwon-do trainees demonstrate higher proactivity. Revealing two subsets provided much valuable information concerning the structure of the analysed data: the people examined were very different. The patients make up a group that contains two sub-groups those with lower and those with higher proactivity (similarly to the TKD group). A strategy based on trusting doctors and strategy “P”- experience, intensity and frequency of pain – depending neither on doctors nor the individuals themselves, were rather similar.
“IDO MOVEMENT FOR CULTURE. Journal of Martial Arts Anthropology”,
Vol. 16, no. 3 (2016), pp. 40–46
DOI: 10.14589/ido.16.3.5
Introduction
Both the psychological sphere and mental condition are very important, as can be seen in the subject literature and by common-sense observation of everyday life. As the results of the conducted research show, we can cau-tiously confirm that certain strategies for coping with pain occur equally in both groups, the people practising
taekwon-do as well as patients undergoing pain treatment.
The question arises as to whether people with high lev-els of fitness who practise taekwon-do on the one hand, and pain therapy patients on the other hand, can share experiences which promote health and recovery.
Data from the literature allow us to make the assump-tion that the level of proactive attitude towards the
experienced ailments is influenced in different ways by the effects of the treatment. It is assumed that people are responsible for their everyday experiences and may strive to a certain extent for their quality of life, just as they can for their health. This reflects an holistic understand-ing of health as a process directed at providunderstand-ing dynamic equilibrium between the subject and their surrounding [Edwards et al. 1992; Wasik, Ortenburger, Gora 2015]. The presence of pain, particularly connected with the tendency to catastrophise the problem, increases anxi-ety and dramatically worsens the patient’s psychological condition [Strong 2008; Dobrogowski, Wordliczek 2004]. Pain perception, together with strategies for coping with pain, are under both the influence of one’s own person-ality and by temporary mediating variables. Coping has
41
Ortenburger D., Wasik J., Bukova A., Gora T. — Comparison of strategies used by patients… been defined as intentional efforts to deal with the
nega-tive impact of a particular stressor [Unruh, Henriksson 2009]. In another study, around one-third of people with pain reported pain as the main stressor in their lives. Hence, the ways of coping with pain are consid-ered important by many different people.
In the present paper, proactivity is understood as a bio-psycho-social model of treatment. It assumes that actively attempting to soothe current physical ail-ments, and the use of different possibilities to prevent any increase in limitations in ability caused by pain, is being beneficial. The benefits of proactivity are visible in the process of regaining health and in situations where attempts are made to increase fitness of healthy individ-uals [Strong et al. 2008].
As the literature on health psychology shows, there are a number of principal beliefs concerning individual abilities for coping with pain: they reflect how people themselves regard the possibility of influencing their own situation when that pain is reduced (its intensity and frequency). The “W”- type beliefs and strategy is referred to as relying on oneself, one’s internal possibil-ities of coping with ailments and pain. In the “L”- type beliefs regarding considerations over the possibilities of influencing the situation, the dominance of health-re-lated belief exists. According to this, it is medical doctors who have the major influence on the situation and can reduce ailments (in respect of the intensity and frequency of pain). In the case of an individual’s “P”- type beliefs there is a dominance of health beliefs that experience, mood, intensity and frequency of pain neither depend on doctors nor the person themself , but on accidental events and external effects [Strong 2008; Cook, Degood 2006; Juczynski 2009]. The aim of this work is to present the results of the research concerning dealing with pain in two different groups: a comparison of pain treatment strategies for dealing with pain in a group of patients undergoing chronic pain therapy and in a group of peo-ple practising taekwon-do.
Methods Material
The paper compiles the results of research conducted in two groups that are considerably different in respect of their physical fitness. The first group was composed of 29 people who practise taekwon-do (TKD), age range: 18-45 years (average 30.5±8.9 years). In the sample group, the majority practise 2-3 times a week, some people prac-tise once or twice a week, and almost the same number of people 4 or more times. The minority practise every day. The second group comprised 30 patients aged 19-51 years (average 33.5±11.9 years) (Patients).
Research tools
Questionnaires used in psychology and health promo-tion were applied in the research (Coping Strategies Questionnaire and Pain Beliefs Questionnaire). Sufficient psychometric value is attributed to them [Strong 2008; Juczynski 2009; Cook, Degood 2006; Edwards et al. 1992]. These measures concern cognitive and behavioural cop-ing strategies that patients can use to help them manage pain. Adjustmen to the patients with chronic pain, or the ability to manage pain, can be measured using the Coping Strategies Questionnaire [Rosenstiel, Keefe 1983]. Two of the strategies assessed in the Coping Strategies Questionnaire are: diverting attention and catastrophis-ing. According to the literature catastrophising is linked with disability and depression [Strong 2009].
Statistical
Due to the fact that the obtained data is self-descriptive (it derives from surveys and questionnaires), the analysis was performed applying the methods recommended for processing “non-acute” imprecise data that frequently appears in the humanities, health science and econom-ics [Gatnar 1988]. Explorative techniques that aim at identifying subgroups within multidimensional data collection were also applied. Among others, cluster anal-ysis with the use of k-means clustering was carried out. Thanks to the above, clusters that possibly differ from one another were identified. The k-means method will produce exact k-different clusters of the greatest possible distinction (minimizing variations inside clusters – and maximizing them between clusters [Everit et al. 2011].
Results
The results obtained indicate that within each group examined there are subgroups (clusters) that are differ-ent from one another with respect to the average result within the variable “proactivity” and the variable “W” - type strategy for coping with pain. The strategies were used by patients undergoing chronic pain treatment and people performing taekwon-do (Table 1 and Table 2). Tables 3 and 4 contain the average values of proactivity and strategies for coping with pain in the research groups (after k-means clustering). Figures 1 and 2 illustrate the average results (after k-means clustering) in terms of proactivity and strategy in the two selected clusters in both groups (TDK N=29 and Patients N=30).
Discussion
The data contained in Table 1 indicate that taekwon-do trainees use the strategy to cope with pain on their own more frequently than patients. Taekwon-do trainees also demonstrate higher proactivity (Table 2). The strategy
Table 1. Coping with pain strategy
Explanatory variable Mean TDK N=29 Patients N=30
(1-36) SD (1-36)Mean SD
W- type strategy 20.03 3.95 13.79 6.89
L -type strategy 10.87 4.09 11.71 5.02
P-type strategy 11.53 3.91 13.68 4.64
W - coping with the situation on one’s own, L - appeared, the strategy based on “trusting doctors”, P - experience, intensity and frequency of pain neither depend on doctors nor the individual.
Table 2. Proactivity
Explanatory variable TDK N=29 Patients N=30 Mean (1-10) SD Mean (1-10) SD
Proactivity 7.55 2.48 4.63 2.18
Table 3. Proactivity and “W” - type strategy – taekwon-do group
Cluster 1 Cluster 2 Variance between clusters Variance from within, inside cluster F p Mean SD Mean SD Proactivity 8.17 1.94 6.50 3.03 15,02 139,43 2,58 0,12 W-type strategy 22.35 1.69 15.60 2.36 287,70 94,33 73,19 0,00 W- coping with the situation on one’s own, appeared
Table 4. Proactivity and “W”- type strategy – patients group
Cluster 1 Cluster 2 Variance between clusters Variance from within, inside cluster F p Mean SD Mean SD Proactivity 3.01 0.82 5.05 1.95 21,16 70,94 9,95 0,00 W type strategy 6.10 3.07 18.05 4.05 918,86 363,84 65,66 0,00 W- coping with the situation on one’s own, appeared
based on trusting doctors and the strategy “experience, intensity and frequency of pain neither depending on doctors nor the person themself” were rather similar (Table 1).
In order to improve the precision and clarity of the description of the clustering analysis, the exposed F-value that derives from variation analysis performed in each examined dimension, for variable proactivity and strat-egy W, is set out in two tables (Table 3 and Table 4). We based this data on the statistical literature which indicates that the F-value is considered to be an accurate indicator of how much a particular dimension discriminates clus-ters [Everit et al. 2011]. The degree of difference between the revealed subgroups was specified based on the cri-terion of differences between subgroups and similarities within groups – shown in table 3 and table 4 (Analysis of variance – minimizing variance inside clusters – and maximizing it between clusters). The result, the identi-fication of two different clusters was obtained through the application of the k-means method (that belongs to non hierarchical methods). This method covered grad-ual optimization i.e. improvements to certain grouping quality indicators obtained in the further stages of input processing. It agrees with the aims of the research, as the aim of non hierarchical algorithms is to find such a
divi-sion that allows an optimal value of a certain criterion to be obtained (Table 3 and Table 4). Criterion opti-mization is obtained e.g. though iterative relocation of objects between groups [Everit et al. 2011; Gatnar 1998].
The literature on health psychology and martial arts for health shows that TKD training may improve a practitioner’s endurance and positive outlook on life [Wasik, Ortenburger 2015], as well as female students’ self-esteem [Finkenberg 1990; Fong, Shamay 2014]. Most studies on the long-term effects of martial arts training agree that martial arts are effective in producing positive social and psychological changes. Evidence has suggested that taekwon-do training may decrease anxiety in adults, improve self-regulation and induce positive mood state changes in college-aged students [Fong, Shamay 2014; Toskovic 2001; Kurian et al. 1993].
The research conducted here revealed that in the group of pain treatment patients the strategy based on “trusting doctors” appeared more frequently than in the taekwon-do group. In the group practising taekwon-do the strategies based on taking matters into one’s own hands dominated. The values calculated for the indicator of proactivity are lower in the group of patients than that of the TKD train-ees. As has been outlined, the patients make up a group that contains two sub-groups, of lower and higher
pro-43
Ortenburger D., Wasik J., Bukova A., Gora T. — Comparison of strategies used by patients…
Figure 1. Th e diagram represents the result of cluster analysis with the use of k-means clustering – Proactivity and “W”- type
strat-egy for coping with pain. Taekwon-do sample group (p<0.05).
Figure 2. Th e diagram represents the result of cluster analysis with the use of k-means clustering – Proactivity and “W”- type
strat-egy for coping with pain. Sample group of patients with chronic muscular and fascia pain (p<0.05).
activity (similarly to the TKD group) (Table 3 and 4). In the group with higher proactivity, a higher average of strategies, based on aiming at coping with the situation on one’s own appeared (Figures 1 and 2).
In the light of the data obtained, the factor referred to as proactivity diff erentiates the examined group of peo-ple practising taekwon-do. In the group of peopeo-ple with a higher median of proactivity, there is a lower median
of catastrophising. Similar results were obtained in the group of patients. Th ough generally there are higher value results within inadaptive catastrophising (people lose interest in activities they previously enjoyed due to being engaged with their ailments), within the same group a lower level of catastrophising is present in the cluster of patients characterized by higher proactivity. In terms of concentration (cluster 1), the medium
val-ues of the indicator of psychological factor specified as belief in interior pain control and the possibility of soothing ailments through taking matters into one’s own hands, are higher.
Another important concept related to respondents’ beliefs is pain appraisal. Individuals are active pro-cessors of information and not passive reactors. Pain perception, together with strategies for coping with pain, are under the influence of personality and tem-porary mediating variables [Dobrogowski, Wordliczek 2014; Hasenbring et al. 2012; Strong 2008]. A number of assessments are commonly used to measure an indi-vidual’s psychological aspects which may arise from, or help stimulate, certain responses to pain [Strong et
al. 2008; Tod 2014; Ortenburger, Wasik et al. 2015;
Wil-liams, Krane 2015]. An individual’s response to pain is very personal. Not all types of pain worry people. Some pain, such as sports-related pain, are treated as a chal-lanege. It has been suggested, in relation to pain, that belief in self-efficacy may partly explain the variability between a patient’s skill level and their performance outside the treatment setting.
In selecting the most appropriate assessment, or bat-tery of assessments, to be used for any particular patient, the aim is to balance the need for a measurement tool which can be administered efficiently. It may be that the most reliable measurement tool is very long-running and patients, sportspeople, and other people all have a short attention span [Hasenbring et al 2012; Strong 2008]. The selection of appropriate measurement tools, while far from an easy task, can be guided by using an assessment model which considers the description of a patient’s pain, the responses of that person to pain, and the impact of pain on a person’s life [Strong et al. 2008].
With reference to health psychology literature, we may talk about main types of coping with pain – whether by reason of education, religion, class, occupational sta-tus or whatever else. Some people will make light of their symptoms, shrug them off, and avoid seeking medical care, others will respond to the slightest twinges of pain or discomfort by quickly seeking such medical care as is available (Mechanic and Volcart 1960).
In systematic reviews of the psychological strategy for coping with pain, Strong [2008] identified a few tri-als that compared these psychological and behavioural factors with other non-medical factors, and Hasenbring
et al. [2012] found 6 such studies of proactive strategy
for back pain treatment. In relation to pain, it has been proposed that self-efficacy beliefs may explain in part the variability between a pain-treatment patient or other sports-person’s skill level and their performance outside the treatment setting [Gage, Polatajko 1994]. Implications for treatment are developed within a wide repertoire of coping strategies for successful adjustment to pain. Pain perception, together with strategies for coping with pain, are influenced by personality and temporary mediating
variables [Unruh, Henriksson 2008]. Comparison [Strong
et al. 2008; Wasik, Ortenburger 2015] showed that
proac-tivity understood under the bio-psycho-social model of therapy assume active undertaking of attempts to soothe current physical ailments as being rather beneficial.
We were looking for an answer to the question: Are there any common points or similar factors in the group of people who have better results in treatment (the group of patients) and people who practise taekwon-do? In the light of the literature about martial arts for health, TKD training (and other martial arts) also tend to focus on mind-body integration through a combination of meditation and physical activity. This combination (meditation and phys-ical activity) is part of many therapies. An increase in calmness during difficult situations improves intentional efforts to deal with the negative impact of the particular stressor [Unruh, Henriksson 2009]. Other results show that aikido training supports taking one’s own responsibil-ity for coping with stressful situations, but no significant difference between aikido levels was found [Reguli et al. 2014]. Different psychological factors and coping strategies bring about different effects. Asking about these common points in the strategies for coping with pain the persons, who differ in the level of physical ability and with respect to many other things, has been burden with the risk of examining heterogeneous groups. However, justified in the light of data of a bio-psychosocial trend, including psychology of health [Hasenbring et al. 2012].
By undertaking this project we hope that the data we have obtained may have a considerable practical value for the work conducted within analgesic programmes in those centres which aim at the comprehensive treatment of pain. The problem we considered has its practical and scientific dimensions. Clinical practice correlated with increasing amounts of scientific research show that an interdisciplinary view on the problems connected with the improvement of an individual’s psycho-physical func-tioning multiplies and strengthens any therapeutic effects. There are implications for treatment to develop a wide repertoire of coping strategies for an individual’s successful adjustment to pain. Apart from improving our understanding of the kinds of non-medical strategies for coping with pain, we believe there is potentially a direct clinical benefit from this research. The investigation of psychological and behavioural strategy is in its infancy and requires further attention. Future research should pay careful attention to the techniques used to measure outcomes – studies will be continued.
References
1. Cook A.J., Degood D.E. (2006), The cognitive risk profile for
pain: development of a self-report inventory for identifying beliefs and attitudes that interfere with pain management,
45
Ortenburger D., Wasik J., Bukova A., Gora T. — Comparison of strategies used by patients…
2. Edwards L.C., Pearce S.A., Turner-Stokes L., Jones A. (1992), The Pain Beliefs Questionnaire: an investigation of
beliefs in the causes and consequences of pain, “Pain”, vol.
51(3), pp. 267-72.
3. Basbaum A., Bautista D.M., Scherrer G., Julius D. (2009),
Cellular and Molecular Mechanisms of Pain, “Cell “, vol.
139(2), pp. 267-284.
4. Dobrogowski J., Wordliczek J. (2004), Medycyna bólu, PZWL, Warsaw [in Polish]
5. Everit B.S., Landau S., Lesse M., Stahl D. (2011), Cluster
Analysis, 5th Edition, Textbook, Wiley Series in
probabil-ity and statististic.
6. Finkenberg M.E. (1990) Effect of participation in
Taek-wondo on college women’s self-concept, “Percept Mot Skills”,
vol. 71, pp. 891-894.
7. Fong S.M., Shamay N.G. (2014), Korean Martial Arts and
Health – Taekwondo, “Martial Arts for Health: Translating
Research into Practice”, Edited by Shirley S.M. Fong, Pub-lished by OMICS Group eBooks USA, pp. 22-26. 8. Graven-Nielsen T., Arendt-Nielsen L., Mense S. (2008),
Fundamentals of Musculoskeletal Pain, IASP Press.
9. Gage M., Polatajko H.J. (1994), Enhancing occupational
performance through an understanding of perceived self-ef-ficacy, “American Journal of Occupational Theraphy” vol.
48, pp. 783-790.
10. Gatnar E. (1998), Symboliczne metody klasyfikacji danych, PWN, Warsaw [in Polish]
11. Hasenbring M.I., Rusu A.C., Turk D.C. (2012), From Acute
to Chronic Back Pain. Risk Factors, Mechanism, and Clin-ical Implications, Oxford University Press.
12. Juczynski Z. (2009), Narzędzia do pomiaru w promocji i
psychologii zdrowia, Pracownia Testów Psychologicznych,
Warsaw [in Polish]
13. Kurian M., Caterino L.C., Kulhavy R.W. (1993),
Personal-ity characteristics and duration of ATA Taekwondo training,
“Percept Mot Skills”, vol. 76, pp. 363-366.
14. Kwissa-Gajewska Z., Olesinska M., Tomkiewicz, A. (2014),
Optimism, pain coping strategies and pain intensity among women with rheumatoid arthritis, “Reumatologia”, vol.
52(3), pp. 166–171.
15. Mechanic D., Volcart E.H. (1960), Illness behaviour and
medical diagnosis, “Journal of Health &Human
Behav-iour”, vol. 1, pp. 86-94.
16. Ortenburger D., Wasik J., Szerla M., Ortenburger A. (2015),
Symptoms concerning persons suffering from chronic pain of cervical and thoracic segment of spine contra selected characteristic of personality, “9th Congress of the European
Pain Federation EFIC: Translating evidence in to practice, Scientific Programme Book”, pp. 63.
17. Rosenstiel A.K., Keefe F.J. (1983), The use of coping
strate-gies in chronic low back pain patients: relationship to patient characteristics and current adjustment, “Pain”, vol. 17(1),
pp. 33-44.
18. Strong J. (2008), Chronic pain problem, “Pain Textbook for Therapists”, Edited by J. Strong., A.M. Unruh, A. Wright, G. Dawid Baxter, Churchill Livingstone, pp.397-410.
19. Strong J., Sturgess J., Unruh, A.M., Vicenzino B. (2008),
Pain assessment and measurement, “Pain Textbook for
Therapists”. Edited by J. Strong, A.M. Unruh, A. Wright, G. Dawid Baxter, Churchill Livingstone, pp. 123-147. 20. Tod D. (2014), Sport Psychology. The basic, Routlege
Tay-lor & Francis Group, London & New York.
21. Toskovic N.N. (2001), Alterations in selected measures of
mood with a single bout of dynamic Taekwondo exercise in college-age students, “Percept Mot. Skills”, vol. 92, pp.
1031-1038.
22. Unruh A.M., Henriksson L. (2008), Psychological,
environ-mental and behaviour dimensions of the pain experience,
“Pain Textbook for Therapists”, Edited by J. Strong, A.M. Unruh, A. Wright, G. Dawid Baxter, Churchill Living-stone, pp. 88-80.
23. Wasik J., Ortenburger D., Gora T. (2015), Report of the
1st World Congress on Health and Martial Arts in
Interdis-ciplinary Approach 17-19 September 2015, Czestochowa,
“Physical Activity Review”, vol. 3, pp. 49-51.
24. Wasik J., Ortenbuger D. (2015), Martial arts in the fight for
health. The comparison of the strategies used by patients in chronic pain therapy and people performing martial arts. 6th
Symposium, „Progress in Pain Treatment. Quarterly Polish
Association of Study for Pain: Journal “Ból” , vol. 16, p. 42. 25. Williams J.M., Krane V. [eds.] (2015), Personal Growth
to Peak Performance, “Applied Sport Psychology”, Seven
Edition, McGraw-Hill International Edition, McGraw Hill Education.
26. Reguli Z., Vit M., Cihounkova J., Novotny R. (2014),
Cop-ing Strategies of Different Levels in Aikido Practitioners [in:]
W.J. Cynarski, A. Niziol [eds.], 3rd World Scientific
Con-gress of Combat Sports and Martial Arts. Abstract Book,
Rzeszow, pp. 81-82.
Porównanie strategii radzenia sobie z bólem u pacjentów objętych terapią przeciwbólową oraz osób trenujących taekwon-do – badanie pilotażowe
Słowa kluczowe: taekwon-do, strategie radzenia sobie
bólem, czynniki psychologiczne, pro aktywność
Abstrakt
Perspektywa. W prezentowanej pracy oparto się na założeniu, że w sztukach walki oraz w procesach terapii odgrywają ważną rolę czynniki psychologiczne, które mają duże znaczenie dla sposobu interpretacji wszelkich odbieranych sygnałów, w tym bodźców bólowych. Ważnym elementem reakcji na ból jest sposób jego spostrzegania i następujące po tym dalsze reakcje. Każdy człowiek aktywnie przetwarza odbierane informacje, a nie jest jedynie ich pasywnym odbiorcą. Kiedy z różnych pow-odów pojawia się ból, podejmowane są różnorakie działania mające na celu jego złagodzenie i osłabienie jego wpływu na codzienne funkcjonowanie, w tym na obniżenie odczuwanego napięcia emocjonalnego. Takie działania, w świetle literatury
z psychologii zdrowia określane są jako różnorakie poznaw-cze i behawioralne strategie radzenia sobie z bólem, przez które rozumie się podejmowanie różnych wysiłków w celu pokonania negatywnego wpływu tego konkretnego stresora na samopoczucie.
Problem. Celem niniejszej pracy jest przedstawienie badań dotyczących strategii radzenia sobie z bólem najczęściej stoso-wanych w dwóch różniących się grupach: pacjentów objętych programem leczenia bólu chronicznego i grupy osób ćwiczą-cych taekwon-do.
Metoda. W przedstawianej pracy dokonano zestawienia wyników badań prowadzonych w dwóch odmiennych gru-pach, diametralnie różniących się od siebie pod względem sprawności fizycznej. Grupa pierwsza składała się z 29 osób trenujących taekwon-do w średnim wieku 30.5±8.9 lat. Druga grupa, składała się z 30 pacjentów w średnim wieku 30.5±8.9 lat. Grupa pacjentów to osoby z różną regularnością korzys-tające z programu przeciwbólowego w Poradni Leczenia Bólu w Zespole Szpitali Miejskich w Częstochowie, z czego część w trybie regularnym, a część w sposób mniej systematyczny. W psychologii opisywanych jest szereg metod pomiaru poczucia własnej skuteczności w odniesieniu do zjawiska radzenia sobie z bólem. W prezentowanych badaniach zastosowano kwest-ionariusze stosowane w psychologii zdrowia, które są używane zarówno w badaniach osób zdrowych jak i u osób chorych (Coping Strategy Questionnaire; Pain Beliefs Questionnaire). Są to kwestionariusze o uznanej wartości psychometrycznej służące do badania poznawczych i behawioralnych strategii radzenia sobie z bólem. Do analizy statystycznej użyto metody analizy skupień k-średnich. Jest to metoda rekomendowana do interpretacji badań „nieostrych” uzyskiwanych w badani-ach kwestionariuszowych, jakie występują między innymi w naukach humanistycznych i naukach o zdrowiu.
Wyniki. W grupie pacjentów i zawodników taekwon-do wyse-lekcjonowano dwie podklasy osób o wyższej proaktywności i wyższej wartości wskaźnika samodzielnego radzenia sobie z bólem. Średni wynik proaktywności w grupie taekwon-do wynosi 7,55±2,48, natomiast w grupie pacjentów 4,63±2,18; w skali od 1 do 10. W obu grupach występują dwie różne
podklasy strategii radzenia sobie z bólem. U zawodników taekwon-do w podklasach wartość wskaźnika proaktywności wyniosła 8,17±1,94 (podklasa 1) oraz 6,50±3,03 (podklasa 2); a średnia wartość strategii typu W 22,35±1,69 (podklasa 1) i 15,60±2,36 (podklasa 2). Natomiast u pacjentów proaktywn-ość była na poziomie 3,01±0,82 (podklasa 1) oraz 5,05±1,95 (podklasa 2); a średnia wartość strategii typu W 6,10±3,07 (podklasa 1) i 18,05±4,05 (podklasa 2).
Wartości wskaźników pozostałych strategii radzenia sobie z bólem wyniosły: strategia L w grupie taekwon-do 10.87± 4.09, a w grupie pacjentów 11.71±5,02; Strategia P w grupie taek-won-do 11.53±3,91, natomiast w grupie pacjentów 13.68±4.64. Dyskusja. Ćwiczący taekwon-do ogólnie przejawiają wyższą proaktywność, częściej spotyka się w tej grupie przekonanie o możliwości własnego, samodzielnego i skutecznego radzenia sobie z odczuwanymi dolegliwościami. Jednakże stwierdzono również to, że w obrębie każdej ze zbadanych grup czyli i w grupie pacjentów i w grupie osób trenujących taekwon-do istnieją nierównoliczne podgrupy różniące się od siebie pod względem proaktywności. Ujawnienie dwóch podzbiorów w obu badanych grupach (skupienie 1 i skupienie 2) dostarczyło cennych informacji na temat struktury analizowanych danych. Tym samym uzyskane rezultaty wskazują, że te dwie strategie radzenia sobie z bólem wykazują się dużą zmiennością w obu badanych grupach. Wartości wskaźników innych zbadanych strategii radzenia sobie z bólem (L –polegania głównie na pomocy zewnętrznej, przede wszystkim lekarskiej i P- prze-konanie o braku osobistego wpływu na redukcję dolegliwości) nie różnią się znacząco w grupie taekwon-do i w grupie pac-jentów. Badania są nadal kontynuowane.
Konkluzje. Ćwiczący taekwon-do ogólnie przejawiają wyższą proaktywność od pacjentów, częściej spotyka się w tej grupie przekonanie o możliwości własnego, samodzielnego i skutec-znego radzenia sobie z odczuwanymi dolegliwościami. Nie stwierdzono różnic pomiędzy zawodnikami taekwon-do, a pacjentami pod względem strategii radzenia sobie z bólem, takich jak poleganie na pomocy zewnętrznej, przede wszyst-kim lekarskiej i przekonanie o roli przypadku, braku osobistego wpływu na redukcję dolegliwości.
